The World Bank pioneered global HIV and AIDS financing early in the emergency and remains committed to achieving Millennium Development Goal 6, to halt by 2015 and begin to reverse the spread of HIV and AIDS, through prevention, care, treatment, and mitigation services for those affected by HIV and AIDS.
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This brief summarizes the updates from
the 2014 paper entitled, The heterogeneous effects of HIV
testing, Welfare impacts of rural electrification : evidence
from Vietnam,... Show More + conducted between between 2009 and 2010 in
Malawi. The study observed the effects of learning
one's HIV status on subsequent risky sexual behaviors.
However, many of these studies rely on non-experimental
designs; use self-reported outcome measures, or both. This
study investigates the effects of a randomly assigned home
based HIV testing and counseling (HTC) intervention on risky
sexual behaviors and schooling investments among school-age
females in Malawi. The study finds no overall effects on
HIV, Herpes Simplex Virus (HSV-2), or achievement test
scores at follow-up. However, among the small group of
individuals who tested positive for HIV, a large increase in
the probability of contracting HSV-2 is found, with this
effect stronger among those surprised by their test results.
Similarly, those surprised by HIV-negative test results see
a significant improvement in achievement test scores,
consistent with increased returns to investments in human
capital. The finding of increased HSV-2 prevalence among
HIV-positive individuals suggests that the conventional
wisdom that those who learn they are HIV-positive will adopt
safer sexual practices should be treated with caution. Show Less -

An extensive multi-disciplinary
literature examines the effects of learning one's HIV
status on subsequent risky sexual behaviors. However, many
of these studies rely... Show More + on non-experimental designs; use
self-reported outcome measures, or both. This study
investigates the effects of a randomly assigned home based
HIV testing and counseling (HTC) intervention on risky
sexual behaviors and schooling investments among school-age
females in Malawi. The study finds no overall effects on
HIV, Herpes Simplex Virus (HSV-2), or achievement test
scores at follow-up. However, among the small group of
individuals who tested positive for HIV, a large increase in
the probability of contracting HSV-2 is found, with this
effect stronger among those surprised by their test results.
Similarly, those surprised by HIV-negative test results see
a significant improvement in achievement test scores,
consistent with increased returns to investments in human
capital. The finding of increased HSV-2 prevalence among
HIV-positive individuals suggests that the conventional
wisdom that those who learn they are HIV-positive will adopt
safer sexual practices should be treated with caution. Show Less -

For young adults living in countries
with AIDS epidemics, getting an HIV test may influence
near-term decisions, such as when to leave school, when to
marry, and when... Show More + to have a first child. These behaviors,
which define the transition from adolescence to adulthood,
have long-term implications on well-being and directly
affect a person's risk of contracting HIV. Using an
experimental design embedded in a panel survey from Malawi,
this study assesses the impact of voluntary counseling and
testing of young adults for HIV on these decisions. The
results show negligible intent-to-treat effect of HIV
testing on behaviors. There is some suggestive evidence on
differential response by wealth and by prior beliefs about
one's status. Show Less -

Ratings for the Multi-Sectoral Human
Immunodeficiency Virus (HIV) and Acquired Immune Deficiency
Syndrome (AIDS) Project (MAP) for Malawi were as follows:
outcomes were... Show More + moderately satisfactory, risk to development
outcome was high, Bank performance was satisfactory, and
Borrower performance was satisfactory. Some lessons learned
included: a sector-wide approach to HIV or AIDS can help a
country with a generalized epidemic achieve positive
results, efficiently. This is achieved through (i) reducing
the administrative burden on the coordinating body (NAC)
through joint work programming, accounting, and reporting
systems; (ii) enabling the coordinating body to develop a
strategic, integrated approach to coordinating the national
response; and (iii) building local ownership of the national
program as a whole. Pooled funding mechanisms are an
efficient tool to support HIV national strategic plan.
Government ownership and setting up proper functional
institutional arrangements is critical to achieving results.
There are benefits of centralized procurement for common
items and high value capital goods in addressing capacity
constraints of sub-grantees. Show Less -

This paper studies the effect of
subjective beliefs about HIV infection on fertility
decisions in a context of high HIV prevalence and simulates
the impact of different... Show More + policy interventions, such as HIV
testing programs and prevention of mother-to-child
transmission, on fertility and child mortality. It develops
a model of women's life-cycle, in which women make
sequential fertility decisions. Expectations about the life
horizon and child survival depend on women's perceived
exposure to HIV infection, which is allowed to differ from
the actual exposure. In the model, women form beliefs about
their HIV status and about their own and their
children's survival in future periods. Women update
their beliefs with survival to each additional period as
well as when their HIV status is revealed by an HIV test.
Model parameters are estimated by maximum likelihood with
longitudinal data from the Malawi Diffusion and Ideational
Change Project, which contain family rosters, information on
HIV testing, and measures of subjective beliefs about own
HIV status. The model successfully fits the fertility
patterns in the data, as well as the distribution of
reported beliefs about own HIV status. The analysis uses the
model to assess the effect of HIV on fertility by simulating
behavior in an environment without HIV. The results show
that the presence of HIV reduces the average number of
births a woman has during her life-cycle by 0.15. The paper
also finds that HIV testing can reduce the fertility of
infected women, leading to a reduction of child mortality
and orphan-hood. Show Less -

The objective of the Nutrition and
HIV/AIDS Project for Malawi are to expand access to and
increase use of essential services for nutrition and HIV and
AIDS. There are... Show More + two components to the project. The first
component is support for nutrition improvement. This
component will have two sub-components: (i) enhancing and
scaling-up maternal and child nutrition service delivery at
community level; and (ii) strengthening sectoral policy and
program development, management and coordination. Canadian
International Development Agency (CIDA) will co finance the
project with CA$13.5 million (US$13.1 million). First
component will finance Non-Government Organizations (NGOs)
sub-projects, consulting services, project management, and
goods (i.e., small equipment, basic pharmaceutical
products). Opportunities to introduce performance based
contracting will be explored during implementation. The
second component is support for the national HIV/AIDS
strategic plan (2011-2016). Under the previous IDA funded
Multi-sector AIDS Project (MAP), the majority of funds
(US$65 million) were made available to support the national
HIV/AIDS response through a pooled funding mechanism (the
HIV Pool) administered by the National AIDS Commission
(NAC). Financial contributions to the HIV Pool are also made
by the Global Fund for AIDS, TB and Malaria (GFATM), which
historically has provided 70 percent of HIV Pool funds, as
well as the U.K. Department for International Development
(DFID). Similar to the current MAP, this project will
contribute to the HIV Pool and the implementation of the new
National Strategic Plan 2011-2016 (NSP). Approximately half
of the IDA contributions to the HIV Pool have been earmarked
for specific interventions to prevent new HIV infections.
This component therefore has three sub-components: (i)
support for the implementation of the NSP 2011-2016; (ii)
Voluntary medical male circumcision (VMMC); and (iii)
Prevention of mother to child transmission (PMTCT).
Opportunities to introduce performance based contracting
will be explored during implementation. Show Less -

The objective of the Nutrition and
HIV/AIDS Project for Malawi are to expand access to and
increase use of essential services for nutrition and HIV and
AIDS. Some of... Show More + the negative and mitigation measures include:
a) chemical wastes must be incinerated at high temperature
or must be disposed of into the sealed pits; b)
pharmaceutical wastes must be disposed of into the sealed
pits and/or must be incinerated at high temperature. Large
quantities of unused pharmaceuticals should be returned to
suppliers if possible; c) staff shall ensure use of
easy-to-clean surfaces for storage and placement of
containers and bags containing healthcare wastes; and d) all
health workers and waste handlers should be offered
hepatitis vaccinations. Show Less -